Poor mental health:
The links between childhood poverty and mental health problems
Poor Mental Health
The links between child poverty and mental health problems
March 2016
By David Ayre
1
Poor mental health:
The links between childhood poverty and mental health problems
Children and young
people growing up in
poverty feel distinctly
less optimistic about
the future than their
more affluent peers
(29% compared to 22%)
Acknowledgements
There are a number of individuals who offered advice and
information for this report. I am grateful to colleagues from our
work in Oldham and Birmingham for support in organising and
running focus groups, and to colleagues from other teams that
have offered their support and challenge. Finally, I’d like to thank
Helena Egan, who in her role as intern supported me with the
review of Government legislation.
2
Poor mental health:
The links between childhood poverty and mental health problems
Contents
Executive summary
4
Introduction 6
Research question 6
Methodology 7
Definitions of mental health and poverty 8
Evidence of the links between poverty and children’s
emotional well-being and mental health 10
Low income and mental health 13
The effect of problem debt on children’s mental health 15
The effect of poor housing and disadvantaged communities
on children’s mental health 17
Policy context 19
Addressing the links between child poverty and mental
health problems through schools 22
Conclusion 23
References 24
1in5
children living in poverty
feels like a failure,
compared to one in seven
of their more affluent peers.
3
Poor mental health:
The links between childhood poverty and mental health problems
Executive Summary
Children’s mental health is beginning to get the
attention that it deserves, and there has been an
effort from Government to achieve parity of esteem
with physical health. However, access to support is
not always easy for those that need it.
There is a wide variety of evidence to show that
children who live in poverty are exposed to a range
of risks that can have a serious impact on their
mental health, including debt, poor housing, and low
income. Our original analysis has found that children
living in poverty are more likely to feel like a failure,
useless and hopeless about their future than their
more affluent peers.
Yet in spite of this evidence, Government policy and
Mental Health Trust priority groups too often don’t
recognise children in poverty as a vulnerable group.
Our research found that only 1 in 10 mental health
trusts see children in poverty as a priority group for
access to mental health services.
This is also set in the context of a projected rise
in child poverty over the next five years. It is a
real concern that cuts to support for low income
families have the potential to entrench the impact
of poverty on the mental health and well-being
of children across the UK. This report sets out a
number of areas for further exploration, and makes
recommendations for Government to better address
the mental health needs of children and young
people living in poverty.
4
Poor mental health:
The links between childhood poverty and mental health problems
Almost
a quarter
of children living
in poverty don’t
feel useful,
compared to
1in6
children from more
affluent backgrounds.
5
Poor mental health:
The links between childhood poverty and mental health problems
Introduction
Research question
It is well established that growing up in poverty can
have a detrimental effect on children’s long-term
outcomes. For instance, there is a recognised link
between growing up in poverty and the resulting
impact on children’s educational attainment1, along
with poorer physical health outcomes2.
What we have sought to achieve and why
However, growing up in poverty is still not
widely recognised as a substantial risk3 for the
development of mental health problems, which
can be a particular problem for families already
struggling to maintain the everyday costs of
supporting their children. There are a wide range of
variables associated with poverty that can have an
impact on children’s mental health, but this report
focuses on three areas that we have identified as
being particular risk factors through our policy and
research work, and from our direct practice: low
income, debt, and poor and inadequate housing.
Successive Governments have sought to achieve
parity of esteem for physical and mental health, and
this report also examines to what extent this intent
has translated into effective action.
Finally, we suggest possible areas that would benefit
from further examination and exploration so as
to better understand both the impact of different
circumstances and the potential benefit of different
interventions.
6
The association between living in poverty and the
development of mental health problems in adults
is well known4. However, while there is a variety
of academic, clinical and policy-based evidence
that demonstrates the nature of the relationship
between children’s mental health and growing up in
poverty, this has not been consistently translated
into policy and practice.
Poor mental health:
The links between childhood poverty and mental health problems
Methodology
How we collected the evidence
Literature review
The evidence presented in this report was
gathered through a combination of analysis of
the available academic literature, Understanding
Society datasets, and other research published
by organisations and institutions with an interest
in children’s mental health or child poverty.
Additionally, we ran three focus groups with children
and young people who have accessed our services,
and included data gathered from a national Freedom
of Information request to Mental Health Trusts
which we collected in 2015.
We conducted a review of available evidence to
better understand common themes, drawing on
academic literature as well as grey literature from
other charities and organisations. This report
also considers Government policy, legislation and
guidance to explore the extent to which the evidence
of the association between child poverty and mental
health is reflected within policy and practice.
Focus groups
By working with our practitioners, we conducted
three focus groups with children aged 9 to 16 with
direct experience of living in poverty and with
mental health issues. These allowed us to gain an
insight into the impact of different aspects of their
lives on their mental health and well-being.
Understanding Society analysis
Freedom of Information (FOI) analysis
In April 2015 we sent out a Freedom of Information
(FOI) request to 54 providers of specialist mental
health services. We received responses from 36
providers who deliver Child and Adolescent Mental
Health Services (CAMHS), a response rate of 67%.
Respondents comprised of NHS Mental Health
Trusts and NHS children’s hospital trusts. Of the
four standalone NHS specialist children’s hospitals
in England, we sent and received CAMHS data
from three.
We conducted original analysis of the Understanding
Society dataset, which allowed us to draw a direct
comparison between the well-being of 16 to 19
year olds living in poverty and those from more
affluent backgrounds.
7
Poor mental health:
The links between childhood poverty and mental health problems
Definitions of mental health
and poverty
Mental health
Subjective well-being is based on two elements:
Throughout the report, the term ‘mental health
problems’ is used to describe different conditions
children and teenagers can experience. This
includes mild, moderate to severe and ensuing
conditions, ranging from anxiety or depression
through to bipolar disorder, schizophrenia and
eating disorders. We recognise a range of terms
exist to describe these conditions and illnesses, but
for consistency and clarity we are using the term
‘mental health problems’ throughout this report.
■■
life satisfaction
■■
xperience of positive and negative
e
emotions at a particular point in time.
Well-being
The Children’s Society has been studying children’s
subjective well-being since 2005. The Good
Childhood Inquiry, launched in 2006, was the first
independent national inquiry into childhood that
sought to better understand modern childhood from
the perspective of children themselves.
Since 2012 we have produced annual reports
reviewing children’s subjective well-being and have
analysed the impact of a range of factors affecting
the way children feel about their lives.
Subjective well-being is about children’s own
assessment of how their lives are going. Are children
satisfied with their relationships with the significant
people in their lives? Are they satisfied with the
environments that they inhabit and how they spend
their time? Are they satisfied with how they see
themselves? Which aspects of their lives do they
rate highly, and which do they rate poorly? How are
their lives going at present, and how do they feel
about the way things are heading?
8
Psychological well-being is concerned with
children’s sense of meaning, purpose and
engagement. Our research also found that children’s
subjective well-being has a moderate association
with measures of mental health problems –
suggesting that there is a link between the two
things, but that they are nevertheless distinct.
Child poverty
Townsend5 defined this as lacking ‘the resources to
obtain the types of diets, participate in the activities,
and have the living conditions and amenities that are
customary...in the societies to which they belong’.
Such resources may include money in itself, but they
may also include other forms of material resources
– such as access to healthcare, a decent home and a
high-quality free education. Children are said to live
in relative income poverty if they live in households
with income below 60% of the household median.
This relative child poverty measure recognises that
it is not enough that children’s basic needs are met,
but they also have the resources necessary for them
to participate in the same activities as their peers.
Poor mental health:
The links between childhood poverty and mental health problems
9
Poor mental health:
The links between childhood poverty and mental health problems
Evidence of the links between
poverty and children’s emotional
well-being and mental health
Understanding Society analysis
This section outlines our analysis of Understanding
Society’s 2015 data release, a longitudinal data
set that covers areas such as income, housing,
health and well-being. We have focused on 16 to
19 year olds living in poverty as these are the most
relevant for this research. Therefore, whilst it is
not a comprehensive assessment of all children, it
offers an indication as to the impact of growing up in
poverty on the emotional well-being
of young people.
Fig 1. Not optimistic
30
25
20
15
As the data in the graph to the right shows,
children and young people growing up in poverty
feel distinctly less optimistic about the future than
their more affluent peers. This in turn has a knockon detrimental effect on their aspirations and the
potential that they believe the future holds for them.
Another correlation between poverty and emotional
well-being is how useful children in poverty feel,
with almost a quarter (22%) saying that they didn’t
feel useful compared to 1 in 6 children from more
affluent backgrounds.
22%
In poverty
Not in poverty
5
0
The impact of poverty on the well-being of
16 to 19 year olds
Our analysis of the Understanding Society survey
has shown (as demonstrated in the three graphs in
this section) that there is an association between
children aged between 16 and 19 living in poverty
and their emotional well-being. For instance, the way
that children and young people view themselves and
the way that they feel about their future prospects
both have significant correlations with living in
poverty.
29%
10
n=2599, p value: 0.001
Fig 2. Doesn’t feel useful
25
20
15
10
22%
18%
In poverty
Not in poverty
5
0
n=2599, p value: 0.103
Fig 3. Feels a failure
20
15
10
20%
14%
In poverty
Not in poverty
5
0
n=2542, p value: 0.001
10
Poor mental health:
The links between childhood poverty and mental health problems
This combination of lack of optimism and self-worth
suggests a negative association between growing up
in poverty for children and young people’s emotional
well-being. This insight is further reinforced by the
number of children and young people growing up in
poverty reporting that they ‘feel a failure’, with the
evidence gathered from our analysis showing that
they are considerably more likely to report this than
their more affluent peers.
Poverty, relationships with family and
friends, and children’s mental health
There is evidence to suggest that being born into
poverty can increase the risk of mental health
problems in children and young people, which in
turn can have long-term consequences for their
educational outcomes and social relationships. In
a recent report6 The Children and Young People’s
Mental Health Coalition7 highlighted that ‘being born
into poverty puts children at greater risk of mental
health problems and, for many, this will lead to
negative consequences through their lives, affecting
educational attainment and social relationships, and
can be cumulative.’
The negative consequences of living in poverty were
well illustrated in our recent work on the Children’s
Commission on Poverty8 (CCP), which showed
that children are acutely aware that their parents
struggle with the cost of school. Where children
were struggling with school costs, in many cases
this led to embarrassment and bullying. Nearly
two-thirds (63%) of children in families who are
‘not well-off at all’ said they had been embarrassed
because they couldn’t afford the cost of school, such
as a school trip or a new item of uniform.
This highlights the stigma which may be associated
with growing up in poverty. Young people told us that
they felt marginalised or misunderstood as a result
of their teachers and peers not appreciating the
realities of living in poverty. Being able to interact
with their peer group is important for children and
young people as they grow up, and this suggests
that growing up in poverty makes it harder to do so.
Stigma and poverty
Stigma from those around them, be that their
friends, peers more broadly, or society as a whole9,
can have an impact on the emotional well-being of
children and young people growing up in poverty. It
may contribute to the higher likelihood of ‘feeling
a failure’ and a lack of optimism for the future, as
described previously. Analysis by the Health and
Social Care Information Centre has found that
one in six 15 year olds in the UK who come from
deprived areas reported having low life satisfaction,
compared with around one in ten of those living
in the least deprived areas10. The young people
involved in the CCP echoed this. One young person
who contributed to the Commission told us:
‘We are still judged on it now
sometimes, some people say
“oh it’s a council house kid”…it
makes me feel quite angry,
maybe their family hasn’t got
enough to buy them clothes
straight away, maybe they can’t
afford the water bill.’11
Furthermore, research by Mind has shown that
perceived stigma leads to loneliness, depression
and loss of confidence, and that the fear of this
type of discrimination can be as damaging as
actual discrimination12. This can have a distinctly
negative effect on young people’s view of the world,
and their place in it, which has an inhibiting impact
on their ability to achieve their full potential, both
at school and also as they grow up and move into
employment.
Comparing children and young people in poverty
with those from more affluent backgrounds
Over the last 25 years research has shown that
growing up in poverty has a detrimental effect on
the mental health and well-being of children and
young people. There is evidence to suggest that
children and young people who live in poverty have
a higher chance of experiencing mental health
problems and lower subjective well-being both as
children, and as adults13.
11
Poor mental health:
The links between childhood poverty and mental health problems
Research published by the Department of Health
in 1999 outlined that children in the poorest
households are ‘three times more likely to have
a mental illness than children in the best-off
households’14. This is made all the more concerning
when evidence shows the impact of persistent and
deep poverty on the mental health of children and
young people.
Original analysis of the National Child Development
Study data between 1958 and 2008 by the Centre
for Longitudinal Studies has shown that children
from the lowest income families are four times more
likely (16%) to display psychological problems than
children from the richest families (4%)15. This is
further reinforced by evidence that shows children
in poverty ‘have more mental health problems than
non-poor children, whether we consider internalising
problems like depression or externalising problems
like antisocial behaviour16.’
This raises the possibility that addressing child
poverty could also have a positive impact on
improving children’s mental health outcomes.
Areas for further exploration
Evidence gathered for this report would appear to
show an association between poverty and mental
health problems, and highlights an approach
that has, to date, not adequately addressed this.
Research into the links between poverty, social
inequality and mental health has demonstrated that
‘conduct disorder and attention-deficit hyperactivity
disorder show links with family poverty, and this
is most marked for children in families facing
persistent economic stress17.’
This suggests that further research into whether
mental health problems fluctuate with levels of
income, and whether money problems (irrespective
of the overall financial situation of a family) have
a detrimental effect, could be instructive for the
development of long-term policy solutions.
12
Poor mental health:
The links between childhood poverty and mental health problems
Low income and mental health
The available evidence that links mental health
problems and low income focuses predominantly
on the experiences of – and outcomes for – adults.
However, there is some evidence that demonstrates
the impact on the mental health of children and
young people. The End Child Poverty coalition
outlines in its Unhealthy Lives18 report that children
in families in poverty are over three times more
likely to suffer from mental health problems than
their more affluent peers. For children in poverty,
1 in 40 children aged 5–10 engages in self-harm,
compared to fewer than 1 in 100 of those with high
socio-economic status. Likewise, a review of poverty
and mental health by the Centre for Social Justice19
highlights that children and adults from the lowest
20% of household income are three times more
likely to have common mental health problems than
those in the richest 20%20, and nine times as likely
to have psychotic disorders21.
The Office of National Statistics’ (ONS) most
recent prevalence survey from 2004 found that in
families with a gross weekly household income of
less than £100, 16% of children and young people
have a mental health problem 22, compared with
5% of those with an income of £600 or more. The
same survey showed that in households in which
someone received disability benefit, 24% of children
and young people have a mental health problem
compared with fewer than 1 in 10 (8%) for those
that received no disability benefit. The prevalence
survey also highlighted some more general concerns
regarding the links between poverty and mental
health in children and young people. It showed how
children with conduct disorders lived in the most
economically disadvantaged circumstances, and
22% of children with a conduct disorder had parents
who had experienced a financial crisis. Furthermore,
another study found that ‘children whose parents
are in poverty or who have experienced severe
economic losses are more likely to report or be
reported to have higher rates of depression, anxiety,
and antisocial behaviours23.’
This evidence seems to suggest that there is a
correlation between growing up in poverty and the
development of mental health problems. It also
appears to suggest that children in poverty are
more likely to develop mental health problems than
their more affluent peers. The recent report24 by the
Children’s Commissioners for the UK – which looks
at welfare reform and austerity measures – outlined
their deep apprehension over future austerity
measures, given the effect that the benefit cap, the
spare room subsidy, benefits sanctions and other
measures have had on the household income for
families already living on low incomes.
The impact of work and benefits
There is also evidence that suggests that growing
up in a household that is in receipt of benefits or is
struggling to find employment can have a negative
impact on the mental health of children and young
people.
For instance, research shows that living on a low
income can cause both physical and mental health
problems for parents and children alike25. Another
study found that poverty and unemployment
were both associated with the persistence of
mental health problems of parents26, while other
research has shown that ‘reductions in family
income, including benefit cuts, are likely to have
wide-ranging negative effects on children’s mental
health27.’
Access to employment
There are also long-term consequences for children
and young people who suffer from mental health
problems in terms of their employment prospects.
Research by the UCL Institute of Education,
the Institute of Fiscal Studies and the Rand
Corporation shows that ‘adults who struggled with
psychological problems as children tend to work
fewer hours and earn less money, and are more
likely to experience unemployment28.’ Research
published by the Association of Young People’s
13
Poor mental health:
The links between childhood poverty and mental health problems
Health29 showed that young people who were not
in education, employment or training (NEET) or
were socially isolated, were found to be twice as
likely as other young people to report mental health
problems. This is corroborated by work from the
ACEVO Commission on Youth Unemployment30
which highlighted the profound impact that youth
unemployment has upon both the young person
that is out of work, and the cost to the Exchequer31.
In terms of the impact upon the young person, the
Commission highlights the ‘scarring effect’ of youth
unemployment, and a negative effect on mental
health, both in the short and longer term.
This suggests that making sure that there are
pathways to employment, not just for the parents
of children in poverty, but also for the children
themselves in the future, is an important factor for
the prevention of mental health problems.
Benefit receipt and children’s
mental health
However, it is not just paid work, but also the overall
amount of money that is received through the
benefits system that can have an impact on the
mental health of children and young people, and
low-income families in general32. Evidence33 shows
the detrimental impact that welfare changes have
had on working families. These changes place a real
strain on the budgets of low-income families.
One critical benefit to help families affected by
mental health problems is the Disability Living
Allowance (DLA) for children. The DLA rate is
between £21.80 and £139.75 a week34 and depends
on the level of help the child needs35. For children
with mental health problems, it can be very hard
to access this benefit, due to the difficulty of
demonstrating an impairment that affects your
ability to function on a daily basis, when compared
to that of a physical disability36. This also presents
a strong example of where the parity of esteem
between physical and mental health is yet to
be achieved.
With the transitory nature of some mental health
problems37, it is hard to show the consistency
of detriment to the individual, and while checks
14
are in place to assess this, they have very narrow
definitions that mean that the likelihood of being
granted the benefit is reduced. The report Future
of Family Incomes38 showed how families with a
disabled child are amongst the worst affected by
cuts to support. For instance, a couple with three
children – one of whom is disabled – in receipt of
the low rate DLA care component would see the
value of the disability addition within their Tax
Credits/Universal Credit entitlement reduced by
half through the introduction of Universal Credit.
Areas for further exploration
This all suggests that the combination of low
income and difficulty in obtaining certain benefits
can leave families with children in situations where
they struggle to make ends meet. They are caught
in a constant juggling act, facing difficult decisions
around what they can and can’t provide for their
families, which in turn can lead to the development
of mental health problems over time.
While there has been research into the impact of
living on benefits on adult mental health, there has
not been an equivalent body of research to explore
the impact on the children in the household, and this
would appear to be an area that would benefit from
further research.
Poor mental health:
The links between childhood poverty and mental health problems
The effect of problem debt on
children’s mental health
Impact of debt
Research by the Royal College of Psychiatrists has
suggested that debt may have indirect effects on
household psychological well-being over time, and
‘potential mental health problems among children39.’
In light of this, and findings from our own research,
this section explores the impact of problem debt on
children’s mental health.
The impact on children
The Children’s Society’s research has shown that
living in a family that has experienced problem
debt40 has a real impact on children – both in terms
of the emotional impact and in terms of the ways
in which they seek to protect their parents as far as
they can.
Around 6 in 10 children living in families with
problem debt who we surveyed for The Debt Trap
said that they often worried about whether their
family had enough money. This was a view that
was shared by their parents, with around half of
parents surveyed (47%) saying that their financial
situation caused their children emotional distress,
and a quarter saying that it resulted in their children
feeling stressed or anxious. One young person
told us:
‘It just makes me feel stressed
because sometimes she puts it
onto me…she will get angry at me
for silly little things.’
Additionally, our work on families with children in
energy debt41 uncovered that children wanted to
protect their parents and did not think badly of them
for being in debt or want to place more demands on
them by asking for more things. One child that was
interviewed for the research told us:
‘She [mum] doesn’t like owing
people money. She paid that
off but we’re going to take it a
lot easier this month, this year.
Because it was too much to even
think about for a whole year,
knowing that you’ve got that
much to pay off.’
This is further reinforced by evidence from the Royal
College of Psychiatrists that sets out how ‘debt may
have indirect effects on household psychological
well-being over time, as it impacts on feelings of
economic pressure, parental depression, conflictbased family relationships, and potential mental
health problems among children42.’
This suggests that children do suffer from the main
‘debt effects’ experienced by those around them
– including their parents and carers. The impact
of parents struggling often cannot be hidden from
children, however hard parents try.
The impact on the whole family
In the absence of extensive relevant data specifically
on children’s mental health, we can gain an insight
from the research on adult mental health and debt.
Our research43 has shown the detrimental impact
that struggling to make ends meet has on the
mental health and well-being of parents and
children alike. Survey respondents and the families
and children that we interviewed reported feeling
stressed, anxious and depressed as a result of their
financial situation.
Other research has focused on the impact of debt
on the mental health of adults. Research from the
Centre for Social Justice highlights the association
15
Poor mental health:
The links between childhood poverty and mental health problems
between debt and mental health, and the impact
that this can have on the physical health of families.
The research states that deprivation ‘causes
physical health problems which greatly increase the
risk of mental illness, particularly depression. The
chronic low level stress of coping with daily hardship
and disadvantage affects the way the body reacts,
impacting on people’s physical health through
higher cholesterol levels, blood pressure and heart
disease44.’
There is evidence that debt can not only cause,
but also be caused by, mental health problems45.
Mind’s In the Red46 report found that almost twothirds (63%) of people in problem debt did not
tell creditors about their mental health problem
because they didn’t think they would understand.
Of the 37% that told their creditors, the majority
were still treated unfairly, with more than 4 in 5
(83%) saying they had been harassed about debt
repayments despite informing the organisation
of their mental health problems. Three quarters
(74%) felt they were treated unsympathetically and
insensitively by staff after telling the organisation.
This is further reinforced by evidence from the ONS
which reports that ‘people with experience of mental
distress are three times more likely to be in debt.’
Of those with mental health problems, 23% were in
debt (compared with 8% of those without mental
health problems), and 10% had experienced a utility
being disconnected (compared with 3% of others).
The impact of parental mental health on
children’s mental health and well-being
There is some limited evidence that suggests that
parental mental health problems can have a direct
impact on the mental health of children and young
people. For example, research looking at the impact
of parental depression on the likelihood of children
and young people having problems with depression
found that around half of children of parents with
depression also develop depression at some point
during their childhood or early adulthood47.
16
Areas for further exploration
As with the majority of issues covered in this report,
the existing evidence showing the link between
factors that exist for people in poverty and the
development of mental health problems is from
an adult perspective. As such, we recommend
that further research be undertaken to explore the
following questions:
■■
I n what way does growing up in a family in
problem debt affect children’s mental health?
■■
o different types of debt have different effects
D
on children’s mental health?
■■
I s growing up in problem debt only associated
with certain types of mental health problems?
Poor mental health:
The links between childhood poverty and mental health problems
The effect of poor housing and
disadvantaged communities on
children’s mental health
Poor and inadequate housing
The quality of housing has an impact on a number
of outcomes for children and young people,
particularly their physical and mental health48. This
is shown to be a result of the number of people living
in the accommodation, the ability to adequately
heat it, and the type of accommodation itself49.
Research by the Chartered Institute of
Environmental Health50 has demonstrated that
there is a significant relationship between poor
housing and mental health problems in children.
The evidence that they present suggests that there
is a causal link between some physical conditions,
such as dampness and overcrowding, ‘both on a
physiological and psychological basis’.
Affordability of housing
Being able to access appropriate housing for the
needs of the family can also have an effect on
the mental health and well-being of children and
families51. Evidence suggests that this situation has
been further exacerbated by the introduction of
the Benefit Cap, which cuts the amount of money
that affected claimants receive in Housing Benefit,
and also the removal of the ‘spare room subsidy’,
which reduced Housing Benefit for social tenants
of working age with more bedrooms than they were
deemed to need. Research by Moat52 has shown
that the £26,000 benefit cap currently in place
means that two bedroom houses will be beyond the
reach of families in receipt of Housing Benefit in
most local authorities within eight years, and that
within 10 years most one bedroom houses would
become unaffordable. This is a situation which will
be further exacerbated by the additional reduction
to the Cap set out in the Welfare Reform and Work
Bill, which will see it reduced to £23,000 in London
and £20,000 outside London, alongside a four year
freeze to Local Housing Allowance rates.
The NHS Confederation Mental Health Network
recognises the ability to access good quality,
affordable housing as something which ‘underpins
our mental and physical well-being53. The policy
changes outlined previously reduce the ability
to access such housing and therefore have the
potential to undermine these positive mental
health benefits.
This suggests that there could be longer term
implications for the development of mental health
problems in children and young people in poverty
if Government policy is contributing to a situation
where families find it harder to secure appropriate
and stable housing.
Links to behavioural issues
The quality of their housing can also have an impact
on the behaviour of children and young people.
Research has shown that children living in poor
housing are more likely to have behavioural
problems, including aggression, hyperactivity
and impulsivity54. Children who have been in
temporary accommodation for more than a year
are three times as likely to have mental health
problems, including depression and anxiety55. This is
corroborated by research by Shelter that has shown
how all of the most common effects of overcrowded
housing – for instance mental health problems –
were ‘rooted in uncomfortable, and often constantly
changing, sleeping arrangements56.’
This suggests that if the Government were to
improve the quality of housing and stability of living
arrangements for low income families with children,
it could go some way towards preventing the
development of both behavioural and mental health
problems.
17
Poor mental health:
The links between childhood poverty and mental health problems
Heating the home
We know from our research57 that being able to
adequately heat their home is of utmost importance
for families. There are serious physical health
consequences as a result of growing up in a cold
home, as evidenced by the Marmot Review in
2011. This research outlines how more than 1 in 4
adolescents living in cold housing ‘are at risk of
multiple mental health problems58’, compared to 1
in 20 adolescents who have always lived in warm
housing.
Research by Sheffield Hallam University59 has
shown that growing up in a cold home is linked to
an increased risk of depression and anxiety. The
Children’s Society’s research60 has also shown
that there is an association with the well-being of
children and young people and the warmth of the
family home, with the families that we spoke to
outlining how they have to cope with ‘the emotional
and psychological fallout from their experiences of
fuel poverty’.
However, despite this, analysis of our FOI of Mental
Health Trusts showed that more often than not
CAMHS service providers did not ask specific
questions in the referral forms and assessments
about the standard of housing that children and
young people lived in. This suggests that there is
insufficient recognition of the evidence outlined
above and its implications.
The neighbourhood impact
There is evidence to suggest that it is not only
the individual family home, but the broader issue
of neighbourhood inequality that can have a
detrimental impact on the physical and mental
health of individuals.
Research by The Children’s Society has
demonstrated that growing up in poverty can
mean living in poor quality housing and in deprived
neighbourhoods. The report Through Young Eyes
surveyed children about the way different things at
home and in their local area affected them. They
told us that safety was a key issue for them, with
over 4 in 10 (42%) children reporting people using
or dealing drugs, and a similar proportion reporting
people being drunk or rowdy in their local area
(39%).
18
Whilst not specific to children, research by Stafford
and Marmot has outlined the impact that levels of
deprivation in a neighbourhood can have on mental
health. Their work61 showed that being relatively
poor compared to the neighbourhood average
means worse health, because of the discrepancy
between them and those living around them. Both
individual and neighbourhood deprivation increased
the risk of poor physical and mental health.
Areas for further exploration
Further research should be undertaken on the
specific impact on children’s mental health of
growing up in a deprived neighbourhood. There is
also a need to examine the prevalence of mental
health problems in children and young people
living in families affected by the Benefit Cap, and
to monitor the impact of the further reduction in
the Cap as it is implemented through the Welfare
Reform and Work Bill.
Poor mental health:
The links between childhood poverty and mental health problems
Policy context
Over the past 20 years, there has been a growing
understanding of children’s mental health, as
successive Governments have sought to further
develop and strengthen the evidence base on what
the issues are, which groups are most vulnerable,
and which interventions work best to mitigate the
impact of mental health problems.
Translating evidence to intent
Despite separate efforts to improve children’s
mental health and the physical health of children in
poverty, the connection between these two concepts
was not explicitly recognised until 2009 with the
release of the New Horizons report62. Our analysis
of the various pieces of Government guidance and
strategy, as outlined previously, revealed that before
then children in poverty were not clearly recognised
when referencing groups at risk of developing
mental health problems, and mental health was not
given specific attention when addressing health
inequalities amongst different social groups. The
New Horizons report provided, for the first time, a
specific Government objective that the link between
poverty and mental health be better understood
by 2020. However, despite initially recognising
this at-risk group, the report did not subsequently
give this group the same level of attention as other
vulnerable groups, such as looked-after children
or those in care. In the following six years since the
publication of New Horizons, different Government
reports have not consistently considered children
in poverty to be a group with a heightened risk of
developing mental health problems.
However, the coalition Government’s Child Poverty
Strategy actively acknowledged the risk factors that
living in poverty can have on parents and children’s
mental health, stating that:
‘Children’s development in
their early years provides the
foundation for later life and
learning. Poorer families can face
the greatest challenges. This is
because of the direct impact on
living standards and the stresses
that poverty puts on family life
such as effects on mental health,
including depression.’63
Encouragingly, in the most recent report by
Department of Health, Future in Mind, children from
low socio-economic backgrounds were considered
a target group for improvement of their mental
health. This is a welcome recognition and provides
a platform for consistent acknowledgement of this
group of children and young people.
Translating intent to practice
The Children’s Society welcomed the establishment
of the Children and Young People’s Mental Health
and Wellbeing Taskforce (2014) to investigate the
gaps in provision of mental health support services
for children and young people. The taskforce
established a number of separate Task and Finish
groups, and this included a specific focus on
vulnerable groups and inequalities. However, there
was no explicit recognition of children and young
people growing up in poverty as a vulnerable
group64.
Whilst both the Conservative election manifesto65
and the Department for Education have made
commitments regarding increased funding for
mental health services and improved waiting times,
there is no indication that children in poverty will be
recognised as an at-risk group.
19
Poor mental health:
The links between childhood poverty and mental health problems
What our Freedom of Information request showed
As part of our research, we sent out a FOI request
to all Tier 3 CAMHS providers, from which we
received 36 responses. We uncovered that there
was insufficient understanding and recording
of measures of poverty and disadvantage as
presenting a heightened risk factor.
Our FOI of NHS Mental Health Trusts showed the
low level of understanding of how poverty can affect
children’s mental health outcomes – only 11% of
providers considered children living in poverty as
a vulnerable group. Information about a family’s
financial and social history is collected during the
referral process, but we are concerned that this
information isn’t used to inform decision making
when prioritising access.
In addition, children living in poverty may face
difficulty in maintaining engagement with services
such as CAMHS, and face challenges when
transitioning out of services, or into adult services,
as evidenced in the table below.
Children living in
poverty
In receipt of
council tax
support
In receipt of free
school meals
In receipt of
Income Support
or JSA
Identified during
referral and
assessment stage
11%
6%
3%
8%
Have fast-track
access to CAMHS
services
0%
0%
0%
0%
Identified in
reengagement
policies
6%
0%
0%
0%
Identified in
transitions policy
3%
0%
0%
0%
Fig. 4 - Percentage of children identified as a vulnerable group by Mental Health Trusts
in referral form and initial assessment by category
only
1in10
Mental Health Trusts
consider children in
poverty as a priority group
20
Poor mental health:
The links between childhood poverty and mental health problems
What gaps still exist?
What are the possible future trends?
The Government’s Better Health Outcomes for
Children and Young People report sets out their
commitment to raising the health outcomes of
children and young people to some of the best in
the world66. The work aims to support and protect
the most vulnerable by focusing on the social
determinants of health and providing better support
to the groups that have the worst health outcomes.
It is suggested that this would include solutions
such as ‘promoting resilience and mental well-being
and providing early and effective evidence-based
treatment for those who need it’. However, without
an explicit reference to children and young people
living in poverty, there is a distinct risk that they will
not receive the additional support that they need.
There is evidence to suggest child poverty is
set to rise during the course of this Parliament.
Research by the Institute for Fiscal Studies67
and The Children’s Society68 has set out the
detrimental impact of Government policy on family
incomes, which will see them struggle to make
ends meet even more. Over the coming five years
the Government will introduce a large number of
changes affecting benefits, tax credits, income tax
liabilities, and earnings. This raises concerns about
the potential negative impact on children’s mental
health linked to the increase in the number of
children living in poverty.
The aims and aspirations outlined in the
Department of Health’s Future in Mind report
regarding access to services are welcome, and
would go some way to ensuring sufficient access to
services. They represent a move towards care being
built around the needs of children, young people
and families, and enabling single points of access
and one-stop shop services so there is no wrong
door for a young person to ask for help. The report
acknowledges that there needs to be an increased
focus on improving care for those who may normally
slip through the gaps. For example, among the most
vulnerable, the Government mention: those involved
in gangs, those who are homeless or sexually
exploited, looked-after children and those in contact
with the youth justice system.
However, unless children and young people living in
poverty are recognised as a group at risk of being
affected by poor well-being and at risk of mental
health problems, there is a risk they will remain
invisible to services and unable to access support.
21
Poor mental health:
The links between childhood poverty and mental health problems
Addressing the links between child
poverty and mental health problems
through schools
One issue that would benefit from further research
is the availability of support for children with mental
health problems in school. Schools play an integral
role in terms of the support they provide to children
and young people’s emotional health and well-being,
and their mental health. The evidence that we have
gathered from our direct work with children and
young people suggests that ensuring they have
access to an adult who they can relate to and talk to
about their problems in a time-appropriate manner
is a critical consideration for schools.
Whilst a number of schools have recognised the
importance of support being made available, there
is an inconsistency in the provision that is supplied
across the country, which means that children and
young people cannot always receive the level of
service appropriate to their needs. The schools that
have responded to the mental health needs of their
pupils have adopted a wide variety of approaches,
and prioritised this within their existing funding –
whether through the Dedicated Schools’ Grant, or in
some cases, the Pupil Premium.
The Government has recently released guidance69
to help schools promote positive mental health in
their pupils, and identify and address those with
less severe problems at an early stage and build
their resilience. It also seeks to help schools identify
and support pupils with more severe needs and
help them make appropriate referrals to specialist
agencies such as CAMHS.
22
However, there is crucial support that needs to
be provided to teachers to make sure they are
equipped to deal with the impact that poverty may
have on the mental health and well-being of children
in schools. Through the CCP, we heard evidence of
the impact that poverty has on children’s school
life, including on their mental health and well-being.
One solution to this was offered by the Children’s
Workforce Development Council, who have designed
training70 with the aim of ‘poverty-proofing’ the
school day. By offering support and guidance,
teachers can better understand the problems that
are faced by children and young people from low
income backgrounds. Yet a similar situation does
not currently exist for mental health problems, and
the children and young people we consulted with
spoke of how some teachers don’t understand
their needs or what is going on in their lives. The
Children’s Society believes the Government should
support the roll out of ‘poverty-proofing’ projects in
schools and look at how they can support children’s
mental health.
Finally, there have also been a wide range of
initiatives that have focussed on developing
resilience through different activities and methods
of learning in schools in an attempt to improve the
ability of children and young people to respond as
positively as possible to difficult circumstances.
More work is needed to establish whether offering
tailored support to children and young people
growing up in poverty could help them to benefit
from increased resilience and be in a better position
to deal with difficult situations later in life.
Poor mental health:
The links between childhood poverty and mental health problems
Conclusion
This report set out to explore the associations
between child poverty and mental health problems.
We found that there is much evidence to support
the view that living in poverty is likely to be a risk
factor for the future development of mental health
problems. Despite this, there is not a strong enough
focus on poverty and low income in mental health
strategies and services aimed at young people.
By doing this, alongside putting more resources
into mental health services targeted at children in
poverty, we can make progress towards providing
better support for disadvantaged children and
young people – allowing them to access the support
they need, when they need it, and providing them
with better chances in life as they transition into
adulthood.
Areas of high deprivation have traditionally placed
a higher level of demand on physical and mental
health services. The recent reduction in support
for vulnerable children and young people at a time
when all the evidence points to an increase in the
prevalence of mental health problems is a worrying
development. Much more could be done to improve
mental health services for children in poverty.
However, it is a real concern that planned welfare
reforms will negatively impact low income families,
and are likely to substantially increase the number
of children in poverty, which may have a significant
impact on the mental health and well-being of
children across the UK.
Recommendations
The Government needs to make sure that families
with children live in a home that isn’t overcrowded
and is warm; that those families and young people
who are struggling with debt can be given the
time and space they need to access support; that
when a family moves into work, they move out of
poverty; and that there is an opportunity to reduce
the potential for poor well-being and mental health
outcomes for children and young people.
1.Government should undertake more detailed
analysis to understand the direct and indirect
impacts of income poverty, welfare reform,
problem debt and housing policy on children’s
mental health.
2.Future children’s mental health policies and
strategies, at both a local and national level,
should consider the available evidence including
the research set out in our report which draws
links between children living in poverty and
mental health.
3.Schools and CAMHS should work more closely
together to embed an understanding of the
impact of poverty on children’s mental health
and well-being.
23
Poor mental health:
The links between childhood poverty and mental health problems
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27
Plugging the Gaps
The Challenges of Estimating the Number of Young Carers and Knowing How to Meet Their Needs
It is a painful fact that many children
and young people in Britain today
are still suffering extreme hardship,
abuse and neglect.
The Children’s Society is a national charity that runs crucial local
services and campaigns to change the law to help this country’s
most vulnerable children and young people.
Our supporters around the country fund our services and join
our campaigns to show children and young people they are
on their side.
Find out more
childrenssociety.org.uk
For the full report go to childrenssociety.org.uk/Publications
For more information on this report, please contact:
David Ayre
Policy Officer, The Children’s Society
e. [email protected]
© The Children’s Society March 2016
Names used in this report have been changed to maintain anonymity. All photographs posed by models
Charity Registration No. 221124
PCR075/0316